Palliative Care and the Aggressiveness of End-of-Life Care in Patients With Advanced Pancreatic Cancer

Jang, Raymond Woo-Jun; Krzyzanowska, Monika K.; Zimmermann, Camilla; Taback, Nathan; Alibhai, Shabbir M.H.

doi:10.1093/jnci/dju424

Cited by 121 publications

(123 citation statements)

References 45 publications

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“…For instance, women had lower odds of hospitalization and receipt of aggressive care in several EOL care studies, whereas individuals who reported a black race/ethnicity, a lower SES, and comorbidities had higher odds. [28][29][30][31][32] Our finding that increased age was associated with lower rehospitalization rates was consistent with results of a Canadian study on EOL care for advanced pancreatic cancer 33 and a US study of Medicare beneficiaries with poor-prognosis cancers in the last 6 months of life. 28 However, this finding was inconsistent with one study, in which increased age was associated with more aggressive EOL care.…”

Section: Discussionsupporting

confidence: 80%

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

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Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual-and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. MethodsIndividuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR).After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. ResultsIn the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). ConclusionIndividuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.

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Section: Discussionsupporting

confidence: 80%

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

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“…39 Palliative care consultations for patients with advanced cancer have also been shown to reduce the quantity and intensity of life-prolonging care received toward the EOL. [40][41][42][43][44] Conversely, the lack of palliative care team consultation has been shown to be a predisposing factor for futile life-sustaining treatments at EOL. 45 An observational study suggested that inpatient palliative care led to fewer or no transitions in care settings at EOL.…”

Section: Eol Care In Oncologymentioning

confidence: 99%

“…These services have been associated with a reduced need for EOL emergency department visits, reduced length and frequency of hospitalization, and fewer intensive care unit (ICU) admissions and in-hospital deaths. [40][41][42][43][44] Palliative care has been shown to reduce symptom burden, improve QOL, and increase the odds of dying at home. Similarly, a 2013 Cochrane Database systematic review that analyzed home palliative care in patients with advanced illness demonstrated a reliable reduction of symptom burden and an increased likelihood of dying at home without a negative impact on caregiver grief.…”

Section: Eol Care In Oncologymentioning

confidence: 99%

NCCN Guidelines Insights: Palliative Care, Version 2.2017

Dans¹,

Smith²,

Back³

et al. 2017

J Natl Compr Canc Netw

110

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“…[6][7][8][9][10][14][15][16]22 Definitions of the financial terms are given in the Appendix (online only). The Johns Hopkins Institutional Review Board approved this study.…”

mentioning

confidence: 99%

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Isenberg

McQuade

et al. 2017

JOP

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Purpose: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. Methods: This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. Results: The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (−25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. Conclusion: The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

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Palliative Care and the Aggressiveness of End-of-Life Care in Patients With Advanced Pancreatic Cancer

Abstract: PC consultation and a higher intensity of PC were associated with less aggressive care near death in patients with advanced pancreatic cancer.

Cited by 121 publications

References 45 publications

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

NCCN Guidelines Insights: Palliative Care, Version 2.2017

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

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